Stroke kills, government ignores

If a new toy hit the market in time for Christmas and it killed one in six children who played with it, there would be mass outrage. If our traffic road toll climbed to 140 people per day, we’d see a road safety blitz across the nation. If a food contamination scare hospitalised one person every ten minutes, there would be widespread hysteria and product withdrawals.

This year alone there will be around 50,000 strokes in Australia – that’s around 140 per day or one every 10 minutes. So why the deafening silence?

Stroke is a blood clot or bleed in the brain that starves brain cells of oxygen and causes parts of the brain to die. It causes the same damage to the brain as a major car accident and it can happen to anyone. But the average Australian is largely ignorant about the signs of stroke and its deadly impact.

Stroke is the nation’s second biggest killer and a major cause of devastating disability. One in six people will have a stroke in their lifetime. About one-third of these will die and about one-third will be left with a significant disability. Despite being made a National Health Priority Area in 1996 and the subject of three national strategies and one review in that time, no comprehensive plan to tackle this largely preventable and treatable disease has ever been funded in a federal budget.

As clinicians and researchers we see the effects of this neglect daily. We have long been advocating for better access to treatment and services. While there have been gains, for example more stroke units and increased access to clot-busting thrombolysis, they have been too few and the deficiencies in the health system are seen at every step of the stroke journey.

The National Stroke Foundation’s biennial audit of acute stroke care in Australia, released on World Stroke Day this year, found that one-third (36%) of stroke patients in specialist centres are being denied access to dedicated stroke units, a six per cent increase since the last audit in 2011. So access to stroke treatment and care in specialist centres over the past two years is not only failing to improve, it has actually deteriorated. We’re going backwards.

In the critical early stages of a stroke, the right treatment decisions can mean the difference between walking out of the hospital and being disabled for life. So where you end up after you have a stroke can be just as important as how quickly you get there. We know that too many patients are being treated on general wards; not in specialist stroke units. This is just not good enough. Being treated in an Australian hospital shouldn’t be a gamble. Every Australian should have access to best practice care but right now, close to half of stroke patients don’t.

Improving access to stroke units will reduce the number of deaths and disabilities. When you get best practice care in a stroke unit you are more likely to go home alive. You are more likely to go home independent. You are less likely to need nursing home care. The National Stroke Foundation Acute Services Clinical Audit found that in 2011 only seven percent of stroke patients eligible for thrombolysis received it. The treatment is known to improve the outcomes after stroke by 30 percent. But then the same report found that only one in three stroke patients arrived at hospital within the window of time necessary to administer the drug which indicates what we know – greater public awareness is needed.

We know that addressing these issues will result in fewer deaths and disability. The only barrier to stroke improvement in Australia is investment.

And post stroke, rehabilitation waits are unacceptably long. The National Stroke Audit Rehabilitation Services Report 2012, released late last year, found poor access to community rehabilitation, poor discharge planning and little access to information on how to avoid another stroke.

The recently released Survey of Stroke Survivors shows that it is the people who suffer stroke, and their families who bear the brunt of the lack of investment over the last 17 years. Many are living with disability that could have been avoided if they had received the right care in the right place; and many are living with enormous need. The absence of any nationally coordinated and available program to support survivors in their adjustment to life after stroke, and to support them in their ongoing recovery means that for most of them (more than 80%) their needs are unmet.

In 2010, funding for stroke research by the Australian Government’s National Health and Medical Research Council (NHMRC) represented only three percent of the total investment in medical research. Cancer received 23 percent. Stroke kills more women than breast cancer and more men than prostate cancer. This isn’t good enough. The stroke community is voicing their outrage and so are we.

The Stroke Foundation is urgently calling on the Australian Government to fund a nationally coordination plan to combat stroke. We add our voice to theirs and ask you to do the same. We support the Fight Stroke campaign and the Call to Action.www.fightstroke.com.au